Pregnancy and maternityThe primary goal of prenatal care is to identify potential risks to the health of the mother or child as early as possible and, if necessary, to. to treat. Which prenatal examinations and consultations women covered by statutory health insurance can claim is regulated in the maternity guidelines of the G-BA. The majority are standard or. Routine examinations offered to all pregnant women. Additional examinations may be considered for pregnancies with special risks and to clarify abnormal findings.
The maternity guidelines also regulate the entitlement to examinations and consultations for women who have recently given birth, the prescription of medicines, dressings and remedies, and the iing of certificates.
At the first checkup, the maternity passport is ied. Only the examinations listed there are preventive examinations, as they are offered according to maternity guidelines within the framework of the statutory health insurance.
In the maternity passport, information on the general health of the pregnant woman, the course of the pregnancy and, if necessary. registered for any complications that have occurred.
In order to detect pregnancies with special risks as well as risk births at an early stage, the following information, for example, is recorded:
– Age of the mother – Pre-existing conditions of the mother (z. B. Diabetes, asthma, epilepsy, heart disease, kidney and thyroid disease, high blood prere, tuberculosis, hepatitis) – Previous premature births, cesarean section, miscarriages – Rhesus factor – Multiple pregnancy – Certain hereditary diseases in the family
Almost all preventive examinations can also be performed by midwives during a normal pregnancy and entered in the maternity passport. Excluded are, for example, ultrasound examinations, for which the pregnant woman must always visit a gynecological practice. It is also advisable to seek gynecological care if any complaints arise during the pregnancy.
Early detection tests during pregnancy
Doctors are obliged to inform and advise about the aims, significance and possible consequences of a test, and, if necessary, to provide information. Eligibility for genetic. Psychosocial counseling. All prenatal examinations are voluntary regardless – that is, an offered examination or test can of course be refused by the pregnant woman.
According to the recommendations of the maternity guidelines, three ultrasound examinations are part of normal prenatal care. They are usually performed in the third, sixth and eighth months of pregnancy.
During the second ultrasound examination, pregnant women can choose whether to have a basic ultrasound examination or an extended basic ultrasound examination performed as an SHI service. Extended ultrasound examination – for which a special medical qualification is required – is used to check the development of the fetus and placenta and allows a more accurate assessment of abnormalities of the fetal organs. It includes a systematic examination of the fetal morphology by a specially qualified physician or an ultrasound examination of the fetus. a specially qualified doctor.
An information leaflet for insured persons developed by the G-BA supports the doctor's explanatory talk about the ultrasound examinations.
HIV test during pregnancy
The medical consultation of the pregnant woman should also cover the risks of HIV infection. An HIV test should be recommended to every pregnant woman, because if the mother is already infected, the probability of HIV transmission to the child can be reduced to less than one percent by effective therapeutic measures.
The woman must be fully informed before such a test is performed. In order to support the informed medical discussion, the G-BA has prepared an information leaflet for insured persons, which contains the essential information to enable the pregnant woman to make an informed decision about giving or refusing consent to the HIV test.
Test for gestational diabetes
Pregnant women are entitled to a two-stage test for gestational diabetes. Gestational diabetes occurs when blood glucose exceeds certain levels during pregnancy. This is associated with a higher risk of urinary tract and vaginal infections, resulting in an increased rate of premature birth, pregnancy-induced hypertension, preeclampsia and some birth complications.
The two-stage glucose tolerance test is performed in the sixth or seventh month of pregnancy: The pregnant woman drinks a sugar solution while fasting. After one hour, her blood is taken from a vein in her arm. The level of blood glucose determines. If the result is unremarkable, no further test is required. Only if the sugar level is elevated, a second, somewhat more elaborate sugar test is carried out after a few days.
If gestational diabetes is diagnosed, the pregnant woman can often normalize the blood glucose levels with a change in diet and increased physical activity. Only a few affected women require additional insulin during pregnancy. An information leaflet for pregnant women supports the medical information discussion.
Determination of the child's rhesus factor
Pregnant women with a negative Rhesus factor have the option of having their child's Rhesus factor determined before birth, as this can determine whether anti-D prophylaxis with immunoglobulins, which prevent the formation of antibodies in the mother's blood (anti-D antibodies), is necessary.
For the test, which can be performed at the earliest from the 12th week of pregnancy, there is no need for additional insulin. If the test can be used with sufficient certainty at the second week of pregnancy, a blood sample from the woman is required. Your blood contains hereditary material of the child, from which the child's rhesus factor can be determined. If the fetus tests RhD positive – the probability of this is around 60% – the pregnant woman should be given anti-D prophylaxis. If the fetus tests RhD-negative – the probability of this is around 40 % – anti-D prophylaxis can be dispensed with. Unnecessary anti-D prophylaxis can thus be avoided.
Without anti-D prophylaxis, antibodies may be formed if the fetal blood mixes with that of the mother – for example, through small injuries to the placenta or umbilical cord during birth. Mixing can also occur during pregnancy without external influence or through interventions such as amniocentesis.
When a woman is pregnant for the first time, anti-D antibodies usually do not harm the child. If she becomes pregnant again and is again expecting a rhesus-positive child, the antibodies can, however, impair its development.
The G-BA has prepared an information leaflet for insured persons to support the doctor's explanatory discussion.
Non-invasive prenatal test for trisomies 13, 18 and 21
Pregnant women will presumably be able to undergo genetic testing from spring 2022 in certain situations – i.e. not as a standard or. Routine testing – a non-invasive prenatal test (NIPT) for trisomies 13, 18 and 21 can be used. Such a blood test can be used at the expense of the statutory health insurance if the question arises in the course of medical antenatal care whether a fetal trisomy could be present and the uncertainty represents an unreasonable burden for the woman. Up to now, this question can only be answered by invasive examinations – amniocentesis (amniotic fluid puncture) – within the scope of SHI services. Puncture of chorionic villi or placental tie – are answered. The most serious complication can be a miscarriage.
For the NIPT, blood is taken from the vein in the pregnant woman's arm and examined in the laboratory. The test result – which is usually available within a week – is based on a statistical analysis of the probability of a fetal trisomy and, in the event of a positive result, must be z. B. be confirmed by amniocentesis. The physician informs the pregnant woman about the test result in a consultation and explains whether, if applicable, the pregnancy will be terminated. further examinations are necessary.
The physician who informs and advises the pregnant woman before and after the NIPT for trisomies must be qualified in accordance with the Gene Diagnostics Act (GenDG) and the guidelines of the Gene Diagnostics Commission and must fulfill the information and consultation obligations of the GenDG accordingly.
The information for insured persons provided by the G-BA (pdf 842.87 kB) must be used by physicians during the consultation for the NIPT for trisomies 13, 18 and 21. Of course, women can also use it already in preparation for it.
Overview of other research
All prenatal examinations and consultations, which are covered by health insurance for all pregnant women, can be found in the maternity guidelines of the G-BA in sections A and C. For example, the maternity guidelines also include offers of testing for genital chlamydia infection, syphilis and hepatitis B.